Suicide is the 3rd leading cause of death among adolescents in the United States; however, more than fifty percent of adolescents who die from suicide have never obtained any mental health services. In keeping with recommendations in the National Strategy for Suicide Prevention (2001), this R34 Exploratory Research Project will develop an intervention that has the potential to be delivered to thousands of at risk adolescents seeking emergency services each year. We will develop and pilot test a theoretically-driven intervention, Teen Options for Change (TOC), which is designed to improve problem recognition, readiness for change, and treatment linkage among disadvantaged urban adolescents at risk for suicide due to either (1) co-occurring depression and alcohol misuse, or (2) recent suicidality (suicide attempt or severe suicidal ideation). TOC incorporates motivational interviewing principles and is based on health behavior promotion models. Intervention components include an Adapted Motivational Interview (AMI) with Personalized Feedback for the adolescent, a brief conjoint AMI focusing on available treatments for the parent and adolescent, use of a culturally tailored Services Information and Decision Aid, and Personalized Follow-Up Notes. Specific aims are: (1) to develop TOC materials (intervention manual; culturally tailored Services Information and Decision Aid; therapist training and fidelity assessment procedures); (2) to conduct a feasibility pilot study to refine the intervention and procedures for the randomized controlled trial; and (3) to conduct a pilot randomized controlled trial comparing TOC to enhanced treatment-as-usual. This trial will enable us (a) to estimate the distribution and variability of primary and secondary outcomes within conditions; and (b) to determine the social acceptance and validity of TOC. In this trial, 1120 adolescents will be screened to identify 109 who meet suicide risk criteria and assent (with parental consent) to participate. The primary outcome, assessed at 2-months, is treatment seeking (defined dichotomously and by level of engagement). Secondary analyses will address (1) the intervention effect on treatment seeking, adjusting for other possible predictors such as age, gender, and severity of index condition; and (2) the extent to which treatment-seeking impacts adolescent outcomes. This project capitalizes upon our interdisciplinary team's substantial experience with interventions for suicidal adolescents, emergency-based interventions for alcohol misuse, motivational interviewing, and the development of culturally tailored decision guides for health behaviors. The project's feasibility is strengthened by the team's extensive experience with adolescent suicide risk management. [unreadable] [unreadable] [unreadable]